National Geographic : 2010 May
• Winkelman. e Institute of Medicine estimates that over all, there are 30 million people with this condition in the United States. While apnea can be treated with a device that forces air down the sleeper's throat to keep the airways open, the treatment of classic insomnia is not so clear-cut. Acupuncture may help---it has long had this role in Asian medicine and is being studied at the University of Pittsburgh sleep center now. Typically, psychophysiological insomnia is treated with a two-part approach. First come the sleeping pills, most of which work by enhancing the activity of GABA, a neurotransmitter that regulates overall anxiety and alertness in the body. ough safer than they once were, sleeping pills can lead to psychological addiction. Many users complain that their sleeping-pill sleep seems di erent, and they feel hungover when they wake up. "Sleeping pills are not a natural way to sleep," points out Charles Czeisler, director of the Harvard Work Hours, Health and Safety Group. Pills can make future insomnia worse, too, a drawback called rebound insomnia. e second step in treating true insomniacs is usually cognitive behavioral therapy (CBT). In CBT, a specialized psychologist teaches the insomniac to think about his or her sleep prob- lems as manageable, even solvable---that's the cognitive part---and to practice good "sleep hygiene." Good sleep hygiene mostly amounts to tried-and-true advice: Sleep in a dark room, go to bed only when you are sleepy, don't exer- cise before bed. Studies have shown that CBT is more e ective than sleeping pills at treating long-term insomnia, but many su erers aren't convinced. "Some people continue in my expe- rience to struggle," says Winkelman. " ey're not super-satis ed with their sleep." activity of REM sleep. For unknown reasons, REM is the time during sleep when we do nearly all our dreaming. As the EEG records this fitful voyage, the polysomnogram technicians also measure body temperature, muscle activity, eye movement, heart rhythms, and breathing. en they look over the data for signs of abnormal sleep or fre- quent wake-ups. When a person has narcolepsy, for instance, he or she plunges from wakeful- ness into REM sleep without any intermediate steps. In fatal familial insomnia, the su erer can never get past the rst stages of sleep; body tem- perature soars and crashes. FFI and narcolepsy cannot be diagnosed without EEGs and other monitoring devices. But Clete Kushida, the clinic director, told me he can spot most people's sleep problems right at the intake interview: There are those who cannot keep their eyes open, and those who just speak of their exhaustion but don't actually nod o . e former o en have sleep apnea. e latter have what Kushida calls "true insomnia." In obstructive sleep apnea su erers, the muscle relaxation that comes with sleep allows the so tissue of the throat and esophagus to close, shut- ting o the sleeper's air passage. When the brain realizes it is not getting oxygen, it sends an emer- gency signal to the body to wake up. e sleeper awakes, takes a breath, the brain is replenished, and sleep returns. A night's sleep for an apnea su erer turns out to really be a hundred micro- naps. Sleep apnea is the behemoth of the sleep center business. Brigham and Women's John Winkelman says that at his sleep center, two- thirds of those examined are diagnosed with the condition. Apnea is a serious problem, implicated in increased risk for heart attacks and stroke. But it is only indirectly a sleep disease. True insom- niacs---people diagnosed with what some sleep doctors call psychophysiological insomnia--- are people who either can't get to sleep or can't stay asleep for no evident reason. ey wake up and don't feel rested. ey lie down and their brains whir. is group makes up about 25 per- cent of those seen in sleep clinics, according to A hard night's day catches up with O cer Brian Eckersley, who works 4:30 p.m. to 3:10 a.m. for the Spokane Police Department. Sleep deprivation is insidious. Staying awake 24 hours causes an impairment equal to three shots of whiskey in one hour.